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Endometriosis and infertility

"Endometriosis as applied to issues of the reproductive medicine”

Interview with Yurii Gerevich, an obstetrician-gynaecologist, reproductive endocrinologist, Candidate of Medical Sciences.

What is endometriosis?

Endometriosis is a  widespread complex disease nowadays. Its essence is about the fact that endometrial-like tissue, is found in various other tissues of the body, where it should not be. First of all, these are the ovaries, fallopian tubes, peritoneum, and retrouterine space. Also, these tissues can appear in completely different organs. They can affect adjacent organs lying next to the genital area, for example, the urinary bladder, rectum, but sometimes these heterotopic tissues are located in entirely different organs. There is such literary information that sometimes the endometrial-like tissue can even get into the eye, and then a woman has the so-called “bloody tears” syndrome during menstruation. The fact is that this tissue undergoes cyclic changes similarly to endometrial tissue. And when the endometrium menstruates, similar changes also occur in this tissue, and blood is released. There are such extraordinary, unusual occasions.

The prevalence rate of this disease has been increasing over the past few decades. The reasons for this are most likely a lifestyle. The fact is that modern women become pregnant and give birth much less.   The number of their menstrual cycles has increased dramatically compared to grandmothers and great-grandmothers who gave birth ten times (they had no menstruation for nine months), and they breastfed each child about a year You can count, they did not have menstruation during a long-time interval. Now the situation has changed. An elongated period of menstruation increases the risks of this disease. There are several hypotheses about all this. The most common theory is that as a result of flowing (this is confirmed), blood always flows through the fallopian tubes into the abdominal cavity of a woman. And now there is a category of women who have a genetic predisposition (which is also confirmed).  These women have particular immunological changes. This fact provokes that parts of this tissue take root, and endometriosis develops further. Why is endometriosis unpleasant and dangerous? It causes a systemic inflammatory reaction, precisely because there is an effect of menstruation, there is an effect of the destruction of the surrounding tissue, and then a local systemic inflammatory effect occurs, which affects many functions, causes the formation of a severe adhesion process, and pain syndrome, and endometriosis-associated infertility.

Is it possible to do IVF (in vitro fertilization) with endometriosis?

Yes, it is possible, and sometimes even necessary. Since endometriosis reduces fertility, pregnancy does not occur in some categories of women. Therefore, for this category of women, it turns out that IVF is the most effective method of overcoming infertility.

Is there a way to cure severe endometriosis?

Endometriosis is fundamentally problematic to cure, because if a woman is young and she menstruates, then, in general, this process cannot be stopped. It is impossible to fundamentally remove all of these heterotopic tissues because there are too many of them, and this process continues. Research is underway, new treatment methods are developed, but so far, the pathogenesis of this disease was not studied so well as to cure it fundamentally. Severe endometriosis can lead to a violation of the quality of life, that is, to acute pain syndromes and so on. There is a treatment for endometriosis, and it aims at improving the quality of life, removing the problems that interfere and disrupt the quality of life. But, unfortunately, we cannot cure it completely.

How many women have endometriosis in percentage terms?

Again, a difficult question, because this disease is often hidden. The scientists conducted a study in which young women underwent laparoscopy. The endometriotic lesions were found in 13% of them. But speaking about the endometriosis, which is diagnosed and which manifests itself, we can say, that, for example, in the United States, this figure is approximately 11% of the entire population of women ageing from 25 to 40 years.

Is it true that the best treatment for endometriosis is pregnancy?

Yes, in general, it is true, because the goal of our medication therapy is stopping the regular menstruation of a woman so that she would have the constant stable hormonal background and there were no cyclical changes. And then this tissue does not menstruate, does not destroy the underlying tissues and undergoes reverse development. Pregnancy is the only physiological state when a woman will not menstruate for a long time. And at the same time, unlike in the methods that we use (which have side effects and when we artificially interfere with this system and as if stop this process), then here, during pregnancy,  it happens naturally, physiologically. 

 A woman has no menstruation for a long time, and this favourably affects the development of endometriosis. So really, pregnancy is the best treatment for endometriosis. Moreover, we know that endometriosis causes infertility, and the very fact of the pregnancy in such a woman is already a great joy. It must be borne in mind, and in no case do not interrupt it, because in the future there may be difficulties to become pregnant

How often do women need to monitor this disease and  how often should they contact specialists?

Usually, this disease manifests itself either as a pain syndrome and impaired quality of life.   Otherwise, during examination and ultrasound investigation, other symptoms or endometrioid cysts, or other symptoms of this disease are found. It is necessary to get regular pelvic exams. You should visit a gynaecologist at least once a year!  It is indispensable to conduct a comprehensive examination and at least once a year to do an ultrasound scan to identify this disease as early as possible, to prevent its neglected cases when it is possible to encounter serious difficulties.

Video: Endometriosis and infertility